Mittelschmerz (ovulation pain): symptoms, causes and treatment

Mittelschmerz is the name sometimes used for ovulation pain, the pain some people feel around the middle of their menstrual cycle when an egg is released. The NHS says ovulation pain can affect anyone who ovulates, which is when an egg is released as part of your menstrual cycle, and that it is caused by the ovary releasing the egg.

The NHS describes it as common, saying it usually lasts a short time and is nothing to worry about. It adds that some women get ovulation pain and others do not.

The NHS says ovulation pain often:

• feels like a dull pain or sharp sudden twinges

• lasts from a few minutes to 1 or 2 days

• happens about 14 days before a period

• only affects 1 side of your tummy at a time

• switches sides each time, depending on which ovary releases an egg

The NHS says ovulation pain lasts from a few minutes to 1 or 2 days. Because it happens about 14 days before the period, it tends to come at roughly the same point in each cycle, and the NHS suggests using a diary or app to track your cycle if you want to see a pattern.

The NHS periods page says it is around the time you ovulate, which is about 12 to 16 days before the start of your next period, that you cannot get pregnant if you do not ovulate, and that some hormonal contraception works by preventing ovulation.

Pain that lasts much longer than 2 days, becomes severe or keeps coming back is not typical of ovulation pain and should be checked.

The NHS says ovulation pain is caused by the ovary releasing the egg. Because the pain switches sides depending on which ovary releases an egg, it may be on the left one month and the right the next.

The NHS also lists conditions that may cause a similar pain: conditions that affect the womb or ovaries, such as endometriosis and ovarian cysts, some sexually transmitted infections such as chlamydia, scar tissue (adhesions) from surgery near the ovaries such as a caesarean section, and an ectopic pregnancy.

It is not always possible to tell ovulation pain from other causes of pelvic or tummy pain by how it feels. The table sets out what the NHS describes for other conditions on the list. Do not try to diagnose yourself; get medical help if you are worried.

If ovulation is the only cause of your pain and it is not severe, the NHS says a warm bath or painkillers, such as paracetamol or ibuprofen, may be all you need.

A GP may advise contraception to stop you ovulating, such as the contraceptive pill or a contraceptive implant. If a GP thinks something else is causing the pain, they may refer you for tests or to see a specialist, and treatment will depend on the cause.

Check the leaflet or ask a pharmacist before taking painkillers, particularly if you have asthma, stomach or kidney problems, or are taking other medicines.

The NHS says you should always get medical advice for tummy pain that does not get better after taking painkillers or keeps coming back.

It says to ask for an urgent GP appointment or get help from NHS 111 if you have tummy pain and the pain is severe and painkillers have not helped, the pain keeps coming back, or you think you may be pregnant.

For possible ectopic pregnancy, the NHS says to call 999 or go to A&E immediately if you have a sharp, sudden and intense pain in your tummy with feeling very dizzy or fainting, feeling sick or looking very pale, because these could mean a fallopian tube has split open.

Most ovulation pain needs no treatment and is looked after at home with simple pain relief. If pain keeps coming back, a GP can examine you, arrange tests and refer you to gynaecology. Some people choose a private gynaecology review or ultrasound scan for quicker answers. Either way, keep a note of when the pain occurs in your cycle, because it helps the clinician.